ARTICLE
Vitiligo usually begins quietly. A small pale patch appears, often on the hands, around the mouth or on the feet, and is mistaken for a fungal patch or a mark left by an old injury. Over weeks or months it becomes clearer that the skin there has lost its colour entirely.
The question that follows is almost always the same: why did this happen. This article sets out what is currently understood about the causes of vitiligo, written by the physicians at AyurMana, a residential Ayurveda hospital in Trivandrum, Kerala.
What vitiligo is
Skin colour comes from melanin, a pigment produced by cells called melanocytes. In vitiligo, these cells stop functioning or are destroyed in particular areas. Without them, no pigment is produced, and the skin in that area turns white.
It affects roughly one percent of people worldwide, across every skin type and ethnicity. It is more noticeable on darker skin, which is part of why it carries more social weight in India than in some other countries, but it is no more common.
Vitiligo is not contagious. It cannot be passed from one person to another by touch, by sharing food, or by any other contact. This needs stating plainly because the belief persists, and it causes a great deal of unnecessary distress.
Why pigment is lost
The central question is what causes melanocytes to stop working. The current understanding is that in most cases the immune system is involved. For reasons that are not fully established, the immune system begins to treat melanocytes as foreign and attacks them.
This is why vitiligo is classified as an autoimmune condition, and why it is more common in people who have other autoimmune conditions.
There is also evidence that melanocytes in people with vitiligo may be more vulnerable to oxidative stress than usual, meaning they are damaged more easily and are less able to recover. The immune response may be partly a reaction to that damage rather than the sole cause of it.
Known causes and triggers
Autoimmune activity
The most established factor. Vitiligo occurs more frequently alongside thyroid disorders, particularly Hashimoto’s thyroiditis, and also with type 1 diabetes, pernicious anaemia and alopecia areata. Anyone diagnosed with vitiligo is usually worth screening for thyroid function.
Family history
Around one in five people with vitiligo has a close relative who also has it. That indicates a genetic component, but it is not straightforward inheritance. Most children of a parent with vitiligo never develop it.
Physical trauma to the skin
New patches sometimes appear at sites of injury, sunburn, cuts or persistent friction. This is known as the Koebner phenomenon and it is well documented. It is one reason why protecting the skin matters once vitiligo is present.
Chemical exposure
Certain compounds, particularly phenols and derivatives found in some industrial chemicals, adhesives and hair dyes, can trigger depigmentation in susceptible people.
Severe stress
Many patients describe the onset following a period of significant stress, bereavement or illness. The relationship is difficult to prove and stress is unlikely to be a cause on its own, but it is reported often enough to be worth noting.
Autoimmune and genetic factors
It helps to think of vitiligo as requiring more than one thing to be true at once. A genetic susceptibility appears to set the background. Something then triggers the immune response, and once it begins, factors such as oxidative stress and skin injury influence how far it spreads.
This also explains why the course varies so much between individuals. Some people have a few stable patches that never change over decades. Others see steady spread over months. A smaller number experience spontaneous repigmentation in some areas without any treatment at all.
Is it contagious
No. Vitiligo cannot be transmitted between people in any way. It is not an infection, it is not caused by diet, and it is not caused by anything the person or their family did.
We include this section deliberately, because the social consequences of vitiligo in India are often harder to live with than the condition itself. Patients regularly tell us they have been excluded from gatherings or asked about their marriage prospects. None of that has any medical basis.
How Ayurveda understands vitiligo
In the classical Ayurvedic texts, the condition is described as Shvitra or Kilasa, understood as a disorder involving Bhrajaka Pitta, the aspect of Pitta associated with skin colour and complexion, together with disturbance in the deeper tissues.
The Ayurvedic approach concerns itself with digestion and Ama alongside the skin itself, on the understanding that what shows on the surface reflects processes further in. Treatment is therefore planned around the individual rather than applied uniformly, and takes account of how long the patches have been present and whether they are currently spreading or stable.
We should be clear about what this does and does not mean. Vitiligo has no guaranteed cure in any system of medicine. What careful treatment can do in some cases is support repigmentation and reduce further spread. How much is possible varies considerably between patients, and any practitioner who promises a certain outcome is not being straight with you.
When to see a physician
It is worth being assessed if you notice any of the following:
- A pale patch that is becoming larger or losing colour completely
- New patches appearing over a period of weeks
- Loss of colour in the hair within a patch, including eyebrows or eyelashes
- Patches appearing after an injury or sunburn
- Any associated symptoms such as fatigue, weight change or hair loss, which may point to a thyroid issue
Early assessment matters more than people expect. Patches that are recent and still active tend to respond better than those that have been stable for many years, and identifying an associated condition such as thyroid disease changes what treatment is appropriate.
Frequently asked questions
Does vitiligo spread to the whole body?
In most people it does not. The commonest pattern involves a limited number of patches that may enlarge slowly. Extensive involvement occurs but it is the exception rather than the rule.
Can the colour come back?
Repigmentation is possible, and occasionally happens without treatment. It is more likely in recent patches, in areas with more hair follicles, and on the face than on the hands or feet. It cannot be guaranteed.
Is vitiligo caused by eating fish and milk together?
No. This is a widely held belief in India with no evidence behind it. Food combinations do not cause vitiligo.
Will my children get it?
The risk is higher than in the general population but it remains low. Most children of a parent with vitiligo do not develop the condition.
Does sunlight make it worse?
Depigmented skin has no protection against ultraviolet light and burns easily, and sunburn can trigger new patches. Sun protection on affected areas is important. That is different from saying sunlight causes vitiligo.
Should I have any tests done?
Thyroid function is usually worth checking, as thyroid disorders occur more commonly alongside vitiligo. Your physician may suggest others depending on your history.
Speak to our physicians
If you have noticed patches appearing or spreading, an early assessment gives more options than a later one. Our physicians at AyurMana in Trivandrum, Kerala can help. Get in touch to arrange a consultation.
